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Smartphone apps for mental health:systematic review of the literature and five recommendations for clinical translation
Get PDFOBJECTIVES: Providing adequate access to mental health services is a global challenge. Smartphone apps offer a potentially cost-effective, available and accessible solution for monitoring, supporting and treating mental health conditions. This systematic review describes and evaluates the usage of smartphone apps across a wide range of mental health disorders in terms of clinical effectiveness, feasibility and acceptability.DESIGN: This is a systematic review of studies examining treatment, self-monitoring and multipurpose smartphone apps for mental health disorders.DATA SOURCES: Studies were identified through a comprehensive search of the Ovid and PubMed databases. Articles published up to 14 January 2024 were included based on predefined criteria.ELIGIBILITY CRITERIA: We included randomised controlled trials that compared mental health apps (single- or multipurpose) with treatment-as-usual or no treatment for clinical populations with mental health disorders. Studies were excluded if they focused on web-based interventions, combined apps with non-TAU treatments or targeted physical health apps.DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened and selected studies, with a third reviewer resolving inconsistencies. Extracted data included study details, participant characteristics, app information and outcome measures related to effectiveness, feasibility and acceptability. A risk-of-bias assessment for each study was conducted.RESULTS: Out of 4153 non-duplicate articles screened, 31 studies met full-text eligibility criteria. These included 6 studies on treatment apps, 4 on self-monitoring apps and 21 on multipurpose apps for a range of mental health disorders. Fifteen were identified as having between some and high concern on the risk-of-bias assessment. While smartphone apps were generally effective and acceptable, their feasibility appeared to decline over time.CONCLUSIONS: Smartphone apps are promising tools for mental healthcare, demonstrating effectiveness and acceptability. However, challenges such as reduced feasibility over time, potential biases and underrepresented demographics require further research. This review proposes five recommendations for improving clinical translation in future studies.</p
Fatigue-creep design of transpiration cooled nickel gas turbine blades via low order aerothermal-stress and crystal plasticity finite element modelling
Get PDFTranspiration Cooling (TC) systems can substantially improve the fuel efficiency of jet engines by allowing them to run much hotter than current designs allow. However, TC systems require radically new designs where large cyclic thermomechanical stresses and creep-plastic deformation can limit the life of core components. This can only be mitigated through integrated design approaches which simultaneously consider the aerothermal and mechanical performance. We develop here a low order aerothermal-stress model (LOM) which combines first order coolant flow and fluid-solid convective-conductive heat transfer calculations with stress calculations in the solid. The LOM provides rapid answers to crucial design questions: how much cooling air and how many cooling holes are required in gas turbine blades for them to operate safely at a given turbine inlet (hot gas) temperature? The LOM also narrows the range of conditions under which Crystal Plasticity Finite Element (CPFE) simulations may be required for fatigue-creep life assessment at final design stages. Our answer to previous pessimistic views on the practical use of TC is that TC systems can actually work thanks to the threefold benefit of cooling holes in reducing metal temperatures, temperature gradients and effective thermal stresses. CPFE simulations confirm this new conclusion, encouraging the wider use of our hybrid design strategy in turbomachines, hypersonic technologies and fusion reactors as well as the take-up of TC systems to deliver durable hydrogen-fuelled turbines for Net Zero.</p
Baseline Functional Connectivity of the Mesolimbic, Salience, and Sensorimotor Systems Predicts Responses to Psychological Therapies for Chronic Low Back Pain With Comorbid Depression:A Functional MRI Study
Get PDFINTRODUCTION: Chronic low back pain (CLBP) is a prevalent and debilitating condition. Cognitive behavioral therapy (CBT) can improve coping mechanisms for CLBP and pain-related outcomes. However, the mechanisms by which they do so remain undetermined. We explored the neural correlates of CLBP symptoms and CBT action using functional magnetic resonance imaging (fMRI) in women with CLBP and comorbid depression.METHODS: Forty individuals underwent fMRI followed by 8 weeks of either treatment as usual (TAU) or one of two CBT in addition to TAU: acceptance and commitment therapy (ACT) or behavioral activation treatment for depression (BATD). Pain intensity, depression, psychological inflexibility, and pain catastrophizing scores were obtained at baseline and follow-up. Functional connectivity (FC) patterns of the salience network (SN), sensorimotor network (SMN), and the mesolimbic pathway (MLP), derived from resting-state fMRI examination were correlated with both baseline and delta (baseline-follow-up) pain-related psychological measures.RESULTS: Individuals receiving ACT and BATD showed reduced depression, psychological inflexibility, and pain catastrophizing. Strong baseline connectivity of the SN and SMN corresponded with higher pain intensity, but strong connectivity of the MLP and precuneus corresponded with lower pain intensity. Pain intensity changes correlated with mesolimbic-salience connectivity following ACT, and with sensorimotor connectivity following BATD. Specifically, stronger baseline FC between the MLP and posterior insula predicted greater pain intensity reduction with ACT, while stronger FC between the SMN and secondary somatosensory cortex predicted greater pain intensity reduction with BATD. FC of the SN correlated with changes in psychological inflexibility across both therapies.CONCLUSIONS: We illustrate the potential of FC as a biomarker of CLBP plus depression and the response to CBT. Our data suggest ACT and BATD have differing underlying brain mechanisms. These findings indicate that FC biomarkers could guide personalized treatment, improving individual outcomes.</p
The effects of recent stressful life events on outcomes in individuals at clinical high risk for psychosis:results from the longitudinal EU-GEI high-risk study
Get PDFBACKGROUND: Recent stressful life events (SLE) are a risk factor for psychosis, but limited research has explored how SLEs affect individuals at clinical high risk (CHR) for psychosis. The current study investigated the longitudinal effects of SLEs on functioning and symptom severity in CHR individuals, where we hypothesized CHR would report more SLEs than healthy controls (HC), and SLEs would be associated with poorer outcomes.METHODS: The study used longitudinal data from the EU-GEI High Risk study. Data from 331 CHR participants were analyzed to examine the effects of SLEs on changes in functioning, positive and negative symptoms over a 2-year follow-up. We compared the prevalence of SLEs between CHR and HCs, and between CHR who did (CHR-T) and did not (CHR-NT) transition to psychosis.RESULTS: CHR reported 1.44 more SLEs than HC ( p < 0.001), but there was no difference in SLEs between CHR-T and CHR-NT at baseline. Recent SLEs were associated with poorer functioning and more severe positive and negative symptoms in CHR individuals (all p < 0.01) but did not reveal a significant interaction with time. CONCLUSIONS: CHR individuals who had experienced recent SLEs exhibited poorer functioning and more severe symptoms. However, as the interaction between SLEs and time was not significant, this suggests SLEs did not contribute to a worsening of symptoms and functioning over the study period. SLEs could be a key risk factor to becoming CHR for psychosis, however further work is required to inform when early intervention strategies mitigating against the effects of stress are most effective.</p
The regulation of the Directors' and Officers' liability insurance: An Analysis of the D&O liability insurance in Common law jurisdictions and China
No full textReducing inequalities through greater diversity in clinical trials –:as important for medical devices as for drugs and therapeutics
No full textIn medicine and public health, the randomised controlled trial (RCT) is generally considered the key generator of ‘gold standard’ evidence. However, basic and clinical research and trials are often unrepresentative of real-world populations. Recruiting insufficiently diverse cohorts of participants in trials (e.g. in terms of socioeconomic status, racial and ethnic background, or sex and gender) may not only overstate the general effectiveness of a technology; it may also actively increase health inequalities. We highlight some general issues in this domain, before discussing several specific illustrative examples in the context of medical devices. High quality evidence on factors that would improve trial recruitment is extremely limited. There is a clear need for research on candidate strategies for improving recruitment of under-represented groups in RCTs. These could include, for example, offering various forms of financial incentives; non-monetary incentives, such as preferential access to the technologies that are being tested if they are found to be effective; and various types of informational messages and nudges; as well as involvement of community partners and champions in the recruitment process. Ideally, recruitment practices should ultimately be based on evidence generated from RCTs. Studies Within a Trial (SWAT), where randomised experiments are built into the actual recruitment processes in RCTs, are an ideal way to gain this evidence. SWAT studies are seeing an increase in traction, as indicated by funding streams in bodies such as the UK-based NIHR. Making greater funding available for studies of this kind is needed to improve the evidence base on how best to improve diversity in trial recruitment
Association between Adverse Childhood Experiences and long-term outcomes in people at Clinical High-Risk for Psychosis
Get PDFAdverse childhood experiences (ACEs) are common in people at clinical high-risk for psychosis (CHR), however, the relationship between ACEs and long-term clinical outcomes is still unclear. This study examined associations between ACEs and clinical outcomes in CHR individuals. 344 CHR individuals and 67 healthy controls (HC) were assessed using the Childhood Trauma Questionnaire (CTQ), the Bullying Questionnaire and the Childhood Experience of Care and Abuse (CECA). CHR were followed up for up to 5 years. Remission from the CHR state, transition to psychosis (both defined with the Comprehensive Assessment of an At Risk Mental State), and level of functioning (assessed with the Global Assessment of Functioning) were assessed. Stepwise and multilevel logistic regression models were used to investigate the relationship between ACEs and outcomes. ACEs were significantly more prevalent in CHR individuals than in HC. Within the CHR cohort, physical abuse was associated with a reduced likelihood of remission (OR = 3.64, p = 0.025). Separation from a parent was linked to an increased likelihood of both remission (OR = 0.32, p = 0.011) and higher level of functioning (OR = 1.77, p = 0.040). Death of a parent (OR = 1.87, p = 0.037) was associated with an increased risk of transitioning to psychosis. Physical abuse and death of a parent are related to adverse long-term outcomes in CHR. The counter-intuitive association between separation from a parent and outcomes may reflect the removal of a child from an adverse environment. Future studies should investigate whether interventions targeting the effect of specific ACEs might help to improve outcomes in this population.</p
Becoming China’s Baudelaire::A Case Study on the Learning and Use of the French Language by Chinese Work-Study Students
No full textThis article explores Li Jinfa’s transformation from a work-study student to “China’s Baudelaire,” whose symbolist poetry features a distinctive “francophone foreignness.” It addresses the “language question”—specifically, French language acquisition and utilization—intrinsic to Chinese students’ encounters with Western thought, culture, and life in the early twentieth century. Employing approaches of historical sociolinguistics, it not only investigates the materials, methods, and environments available for Li’s French language acquisition but also examines how he learned and used the language. It argues that, more than just a means for studying abroad, the French language was deeply intertwined with French literature, culture, and quotidian life in shaping Li’s engagement with a foreign world as a work-study student and with literary expression as a symbolist poet. Moreover, rather than serving solely a collective mission toward either Enlightenment or revolution, francophone education among work-study students fostered personal journeys of self-discovery.</p
Utilising multimodal imaging to perform in vitro Investigations Assessing Erosive Tooth Wear Challenges on Natural Human Enamel
No full textForget the facts:a humanistic approach to addressing contemporary issues in urban waste management
No full textDespite public knowledge of the impacts of litter on environmental preservation efforts, volumes of litter continue to grow at alarming rates. In reviewing the history of litter research, a trend of focusing primarily on changing behaviour is apparent, while there remains very little understanding of the behaviour itself. By leveraging principles of radical research, a focus on understanding how items are littered identifies that a large portion of litter is generated unintentionally, calling into question the effectiveness of communication with a public who is not aware of the consequences of their actions